Breathing exercises for pulmonary emphysema. Exercise therapy and massage for pulmonary emphysema, bronchial asthma, pulmonary tuberculosis. Forms of pulmonary emphysema

Why does pulmonary emphysema occur? Is it possible to treat the disease with the help of special gymnastics. What exercises can help treat emphysema?

What is emphysema?

This is the expansion of air bubbles. At the same time, during exhalation, the pulmonary vesicles do not collapse, and during inhalation, accordingly, they practically do not increase: after all, they are already enlarged. Gas exchange is disrupted, the body receives less oxygen. Not only the lungs are affected, but also other organs and tissues. First of all - blood vessels and heart. Lack of oxygen contributes to the fact that connective tissue begins to develop rapidly in the lungs and bronchi. In this case, the lumen of the bronchi narrows, the structure of the lungs is disturbed. Oxygen enters the body even less, and, as doctors say, a "vicious circle" develops.

Why does it arise?

Cause of emphysema- not cured on time,. All these ailments are manifested by a cough, which patients do not always pay attention to. They come to the doctor even when the chest increases, becomes barrel-shaped, and the patient literally has nothing to breathe: after all, all the pulmonary vesicles are overflowing with air and do not provide the body's needs for oxygen.

How does emphysema manifest?

In addition to changes in the shape of the chest, emphysema is manifested by coughing, weakness, and fatigue. Due to the lack of oxygen, it becomes difficult for a person to perform even ordinary physical activity. When breathing, the patient often puffs out his cheeks. There may be blue lips, nose, fingertips.

How is emphysema treated?

When treating, it is important to influence the factors that caused this disease. If it is bronchitis, asthma, pneumonia or silicosis, then you need to take measures to get rid of them or at least reduce the number of exacerbations. If pulmonary emphysema- a congenital condition, then surgery often helps: the affected part of the lung is removed, and the person begins to feel healthy again.

But all measures will be useless if the patient smokes: after all, smoking causes inflammation of the bronchial tree.

With an exacerbation of inflammation in the bronchi and lungs, the doctor prescribes antibiotics. You should not use them on your own, you can harm yourself. If a person suffers from asthma attacks, then drugs are prescribed to remove them (atrovent, berodual, theophylline, etc.). Expectorant drugs (bromhexine, ambrobene,) contribute to the fact that phlegm begins to drain better, the bronchi and lungs are cleared. All these measures will help to improve the condition, but nothing more. Emphysema of the lungs is a disease that cannot be cured... At least if all the lungs are affected.

Breathing exercises

Since the structure of the pulmonary vesicles in emphysema is disturbed, the respiratory muscles are tired in patients. Indeed, in order to somehow provide the body with oxygen, they have to overcome increased resistance. Therefore, it is important to conduct workouts that promote normal muscle function.

First of all, you need to train the diaphragm, which separates the chest and abdominal cavities. The diaphragm is trained lying and standing.

The patient stands with legs wide apart; taking his arms to the sides, he inhales, then, moving his arms forward and bending down, he makes a slow exhalation, during which the abdominal muscles should be drawn in.

If the patient is lying on his back, he puts his hands on his stomach and exhales for a long time, blowing out the air with his mouth; with his hands at this time, he presses on the anterior abdominal wall, increasing exhalation.

It is important to place the breath correctly. In addition to patients suffering from lung diseases, opera singers are engaged in these exercises. Correct breathing allows them to pull notes for a long time.

Taking a slow full breath, you need to briefly hold back the air and exhale it with short strong jerks through the lips, folded into a tube, without puffing out your cheeks. Such breathing will facilitate the passage of phlegm.
Taking a full breath, you can hold it, and then with one sharp effort "push" through the open mouth, closing the lips at the end of the exhalation. Repeat two or three times.
Take a full breath, hold the air for a few seconds. Immediately stretch your relaxed arms forward, then clench your fingers into fists. Building up the tension to the limit, pull your fists to your shoulders, then slowly and with force, as if pushing off the walls, spread your arms to the sides and quickly return your hands to your shoulders. Repeat the last movements 2-3 times, and then, relaxing, exhale forcefully through the mouth. Then do the first exercise
Cope with breathing problems will help yoga exercises: it is necessary to inhale for 12 seconds, then hold your breath for 48 seconds and exhale air for 24 seconds. It is best to do this exercise not once, but two or three times in a row.
It is also considered useful breathing through creation so-called positive end-inspiratory pressure... This is not so difficult to implement: this requires hoses of various lengths (through which the patient will breathe) and the installation of a water seal (a can filled with water). After inhaling deeply enough, exhale as slowly as possible through the hose into a jar filled with water. All this allows you to train the respiratory muscles.

When should i see a doctor?

If you have a prolonged (several weeks) cough during the day.
If you start to be bothered by coughing in the morning (smokers are no exception, on the contrary, they need to take special care of themselves!).
If a large amount of phlegm (especially purulent or bloody) is secreted when coughing.
If you have changed the nature of your cough: for example, from the morning it has turned into a permanent one, or a harsh night cough has been added.
If you feel short of breath on exertion.
If you have coughing or shortness of breath from time to time and cannot understand what these attacks are related to.
If you have a diagnosis in your medical card: chronic pneumonia, bronchiectasis, chronic obstructive pulmonary disease. In this case, be sure to see a doctor at least 1-2 times a year (for prevention!). Practice shows: people who were treated regularly and on time rarely get sick with emphysema.

A common form of nonspecific lower respiratory tract disease is pulmonary emphysema. Often the disease develops after chronic obstructive bronchitis... The connective tissue lining the respiratory organs from the inside loses its elasticity, gradually changing into fibrous tissue. The lungs cease to fully contract, their size begins to increase, this condition leads to.

The chest is almost motionless, breathing becomes shallow... Particularly dangerous is the inadequate supply of blood with incoming oxygen, carbon dioxide is hardly removed from the body. This pathology is the cause of acute heart failure.

Important! Doctors recommend performing special breathing exercises with emphysema, which help to increase the internal ventilation of the pulmonary alveoli, reduce the symptoms of shortness of breath, and form the muscles of the respiratory organs.

Respiratory gymnastics is a combination of gymnastic exercises, breathing techniques that help to strengthen the muscles of the press, back, intercostal region. Helps Improve Muscle Coordination, conscious observation of one's own breathing, increases overall well-being.

Gymnastic exercises will also be useful for a healthy person, will help improve vitality, and will minimize the symptoms of oxygen starvation.

Why do you need breathing exercises?

Respiratory failure with pulmonary emphysema develops due to insufficient supply of oxygen to the body and removal of carbon dioxide. Gymnastic exercise is primarily aimed at preventing the occurrence of this condition. With the correct execution of tasks, the muscles of the lungs begin to contract rhythmically. The patient's shortness of breath disappears.

The main feature of the disease- residual air remains after exhalation, leading to a deterioration in gas exchange. Gymnastics aims to achieve the following goals:

teach how to properly inhale, exhale concentrated;
train a long exhalation;
improve the process of gas exchange in the lungs;
teach to breathe with a diaphragm, this contributes to effective gas exchange;
normalize the psychoemotional state of the patient with emphysema;
strengthen the muscles involved in the breathing process;
teach to control breathing at home while doing physical work.

Fact! Gymnastic exercises help to compensate for the inconsistencies that have arisen, help a person learn to breathe regularly in conditions of reduced lung functionality.

Medical professionals recommend alternating exercises with rest pauses during breathing exercises. The body of a sick person has difficulty accepting physical activity, shortness of breath begins, gymnastic tasks are carried out in small dosages.

The high-quality conduct of breathing exercises largely depends on the initial position taken by the patient with pulmonary emphysema. The effectiveness, the success of the tasks carried out depends on this. Doctors have determined that the best results are achieved when patients do exercises using the "lying", "standing" positions. Then the activity of the respiratory organs is most favorable.

Proper breathing exercises lead to:

an increase in lung volume;
teaching the patient to breathe correctly;
treatment of various diseases;
improving the quality of life;
the formation of strong immunity;
activation of the protective functions of the body;
increased vitality.

Complex of special exercises

Static exercises:

Pronunciation of consonants during exhalation (3-4 minutes). Sit comfortably on a chair with a back. This position automatically lengthens the expiration, the sternum begins to vibrate, this leads to the appearance of a cough, the removal of phlegm from the lungs. This exercise helps to train the time of inhalation, exhalation.
Breathing with prolonged exhalation. Repeat up to 6 times. The task is performed in a sitting position. It is necessary to make a very strong exhalation, in parallel try to count as many numbers as possible. This task involves pressing on the sternum area with your hands during exhalation.
Pronunciation of hard vowel sounds "o", "a", "and", "y" at the moment of exhalation (3-4 minutes). The task is carried out using the "standing" position. Vowel sounds are pronounced very loudly, drawn out. At this stage, they try to lengthen the exhalation.
Breathing in the diaphragmatic region. Repeat up to 7 times. Count "one, two, three" and take a strong breath. The chest expands, the abdomen is drawn in deeper. On "four" exhale, the chest will go down, the stomach will stick out.

Each dynamic exercise listed below is recommended to be repeated 6 times:

Lying position, bending the body forward. Lie on a hard surface, inhale air, raise the upper body, bend as far forward as possible, bring the upper limbs back, exhale.
Push-ups using the supine position. Bend the lower limbs at the knees, grab them with your hands. Take a strong breath. Exhale using the diaphragm, while simultaneously protruding the stomach and straightening the lower limbs.
Rotation using the "sitting on a stool" position. Try to spread your knees as wide as possible to the sides. Raise your hands to the level of the chest, elbows apart, place the hands at the level of the chin. Inhale, rotate to the left, exhale - return to starting position. Then inhale, turn to the right, exhaling, return to the starting position.
Stretching using a standing position. Stretch your arms up, trying to bring them back a little at this moment, take a breath. Turn your head, look at your hands. Synchronously with the exhalation, lower the upper limbs, bend the right leg at the knee, wrap your arms around it and pull it up to the chest as much as possible.
Walking. Carried out for at least 3 minutes. If the physical condition of the patient allows the task, then walking up the stairs helps to quickly improve overall well-being. After inhaling, the patient rises 2 steps up, exhaling - overcomes 4 more steps up.

Fact! Performing this task, you should carefully monitor the rhythm of breathing, its depth.

If it is not possible to climb the stairs, then the task is performed as follows: inhaling, go through 4 steps, exhaling - 8 steps, i.e. twice as much. After a week of systematic performance of this task, it is supplemented with an inhalation by raising the arms up, exhaling - by lowering the arms down.

Attention! Gymnastic tasks, during which small, medium muscle groups are involved in the work, are repeated 3-6 times, with the involvement of large muscle groups - 1-3 times, special exercises - 3.4 times. In all cases, the pace should be slow.

Walking, breathing rhythmic: inhale - 2 steps, exhale - 4 steps.
Lie on your stomach. Bend in the lumbar spine, parallel lifting up the lower limbs, head and inhaling. Exhaling, return to the starting position, relax all muscles.
Take a standing position, place the upper limbs on the lower part of the sternum. Inhale and rise on toes, exhaling - lower down on the entire foot, squeeze the sternum with your hands.
Sit on a low bench, spread the upper limbs to the sides. Rotate the upper body alternately in opposite directions: one side implies a strong inhalation, the other - exhalation.
Take a position "sitting on a chair", lean on the back, take a breath. Fold your hands on your stomach. At the moment of deep exhalation, pull the stomach into yourself, press on it with your hands.
Take a pose "sitting on a chair", lean on the back, fold your hands on your stomach. Inhaling, take your elbows as far back as possible, with deep exhalation - bring your elbows closer together, press your fingertips on the walls of the abdomen.
Take a supine position. Breathe with the diaphragm, gradually increasing the duration of exhalation.
Take a supine position. Exhaling, bend your knees, wrap your arms around them, press them as much as possible to the chest; inhaling - to return to its original state.
Take a supine position. Exhaling, sit down, bend forward as much as possible, reaching with the tips of your fingers toes; inhaling - to return to its original state.

Respiratory gymnastics: video

Video instruction of gymnastics:

Principles of Remedial Gymnastics

Gymnastic exercises for pulmonary emphysema can be performed even when bed, half-bed rest is recommended by the attending physician. In this case, the patient lies on the bed or takes a sitting position on the bed, chair, be sure to lean on his elbows. Ideal if the exercises are done while standing.

Fact! The gymnastic complex of breathing exercises is expiratory, i.e. the tasks performed form a full, high-quality breath of air in the patient, help to strengthen the muscles of the peritoneum, trunk, and allow to form the mobility of the chest.

Medical professionals advise to adhere to the following principles during a special set of breathing exercises:

Tasks are performed daily, 4.5 times for 16-20 minutes. The room must be ventilated beforehand.
When performing tasks, pay attention to the rhythm of breathing, it should be constantly the same.
Individual exercises are performed at least 3 times.
The duration of the exhalation should be longer than the inhalation.
Rushing through assignments can be harmful, as can over-stressing.
When performing breathing tasks, the pace should be medium.
It is forbidden to hold your breath.
For better diaphragm operation, breathe in air through pursed lips, exhale through the nasal cavity.
It is forbidden to take quick breaths, since the alveoli of the lungs in this case quickly stretch.
The complex consists of 2 types of exercises: static, dynamic.
With emphysema of the lungs, breathing exercises always begin with static tasks, which, during execution, always alternate with elements of dynamic exercises, pauses for rest.
People with this diagnosis are advised to follow a healthy lifestyle: walk for a long time, swim, give up unhealthy foods, smoking, alcoholic beverages.
An annual stay in the spring or autumn on the sea coast, for example, in the Crimea, is mandatory. In the summer, during the hot period, it is undesirable to have a rest at the sea.

Important! You should not allow skipping the execution of tasks, this can pause the result.

Daily special exercises of breathing exercises help the patient with emphysema to alleviate the severe course of the disease, and helps to improve overall well-being. Systematic execution of tasks helps to achieve a positive result in a minimum period of time, helps to fix the obtained result for a long time.

Emphysema of the lungs is a rather unpleasant pathology that interferes with full breathing. Over time, the organ without proper help increases in size and pneumosclerosis of individual parts can develop, as well as many other unpleasant consequences. Therefore, with emphysema of the lungs, doctors always prescribe breathing exercises not only to increase ventilation of the lungs, reduce shortness of breath, but also to improve the patient's well-being in general.

With emphysema disease, the cells of the lungs change and cavities form in the organ, which often reduce the useful volume required for breathing. Gas exchange in these cavities is much slower than in healthy lungs, so patients experience shortness of breath and respiratory failure. One of the tasks of breathing exercises is to teach a person with limited lung capacity to breathe correctly.

With regular exercise, there are beneficial effects such as:

Increased inspiratory length;
Breathing control during exercise;
Improving the psycho-emotional state;
The efficiency of healthy organs of the respiratory system increases;
The muscles involved in the breathing process are strengthened;
Inhalation and exhalation become more conscious, which helps to smooth out the effects of respiratory failure.

For people with pulmonary emphysema, breathing exercises are an integral part of the treatment of this disease.

Indications for use

Indications for a complex of breathing exercises include various diseases of the upper respiratory tract, such as:

Asthma;
Frequent and prolonged runny nose;
Adenoids;
Gastrointestinal ailments;
Being overweight;
Systematic colds;
Allergy;
Diseases of the skin.

This list is far from complete. That is, breathing exercises helps not only with emphysema, but also has a positive effect on the state of the body as a whole. It is, of course, not a panacea, but it can alleviate severe symptoms and reduce the risk of dangerous complications.

Exercise principles and rules

Respiratory gymnastics for emphysema includes exercises that help to take a full breath, strengthen the muscles of the peritoneum and trunk, as well as others involved in the breathing process, restore the mobility of the sternum. Half-bed and even bed rest are not barriers to exercise. It is optimal, of course, to do gymnastics while standing, but if it is not possible, then the options lying or sitting on a chair are also suitable.

Inhale slowly through pursed lips and exhale through your nose. This will make the diaphragm work. It is impossible to inhale quickly, as this will lead to stretching of the alveoli and can harm the patient. Respiratory exercises are performed four times a day for 15 minutes, each exercise is also done three times. If desired, the number of times can be increased, but you should not decrease it, otherwise the effect will not appear. Before the session, it is necessary to ventilate the room, as the air must be fresh.

In the process of doing the exercises, it is important to ensure that breathing is rhythmic. Exhalation should be lengthened gradually, as with emphysema, air is often not completely exhaled. You cannot breathe too quickly, as well as hold your breath, all exercises are performed at an average pace that does not change during the day. It is worth starting gymnastics with static exercises, which involve less load, and then move on to dynamic ones.

A set of breathing exercises

There is a whole range of exercises for patients with emphysema. With their regular implementation, the patients' well-being becomes much better.

Static exercises

In a sitting position on exhalation, consonants should be called for 2 - 3 minutes. If the exercise is performed correctly, the vibration of the chest will be felt, and the exhalation will lengthen automatically.

Place your hands at the bottom of your chest. As you inhale, rise on your toes, while exhaling, touch the floor with your heels. To enhance exhalation, squeeze the chest with your hands.

Sit down, spread your arms to the sides and turn the body to the right and left. To increase the swing amplitude, you can ask someone to help.

Sit on a chair, lean on the back, fold your hands on your stomach. Taking a deep breath, draw in your stomach and squeeze it with your hands.

Sit on a chair, lean on the back, hands on the stomach. When inhaling, the elbows are pulled back, when exhaling, they are brought together in front. In this case, it turns out that the fingers press on the stomach.

Lie on your back and breathe deeply with your entire diaphragm.

Dynamic

One of the simplest exercises is walking. While walking, inhale in two counts and exhale in five.

For the next exercise, you will need a gymnastic wall or some other comfortable and reliable support. You need to grasp the support with your hands at chest level and squat, so that when directed downward, exhale, and when directed upward, inhale.

From a supine position, as you exhale, raise your knees to your chest, while inhaling, return them to their original position.

Lying on your back, raise the body and bend forward, trying to reach your toes with your hands while exhaling, while inhaling, return to the starting position.

Lying on your stomach, while inhaling, bend in the lower back, trying to reach your head with your toes, while exhaling, return to the previous position.

Respiratory trainers in the treatment of pathology

Breathing simulators come to the aid of those who are not able to perform the exercises on their own, for example, an elderly person will not be able to do everything. In addition, breathing machines reduce the amount of time you have to spend on exercise and also help you to properly distribute your strength. With the use of simulators, the time for gymnastics is reduced to 3 - 30 minutes a day, and the effectiveness remains the same.

There are special techniques developed for training on simulators, which involve a gradual increase in load. A noticeable effect occurs already after 3 to 4 months of regular exercise.

Features of breathing exercises for emphysema

For those who cannot or do not want to use a breathing simulator, there are also quite a few techniques. The most common of them are Strelnikova's gymnastics and breathing according to the Buteyko system.

This technique consists of a small number of exercises. It is worth starting with the first three, and then gradually add one more. It is advisable to do this kind of gymnastics twice a day. At the initial stage, a 10-second rest is allowed between movements, later it should last only a couple of seconds. It is necessary to inhale through the nose, shortly, sharply and deeply. Then passive exhalation through the mouth.

Stand up, raise your arms to shoulder level, inhale sharply, hugging yourself by the shoulders so that your arms do not cross. It is optimal to do 8 - 12 movements, but if it is difficult, then it is permissible to perform at least 4.
Stand straight, spread your feet shoulder-width apart. From this position, a sharp breath is taken with a light squat and float to the right. Then return to the starting position and a similar turn to the right. In this case, the back is straight, the body turns at the waist, the knees are slightly bent, the hands seem to be trying to grab something. You also need to do 8 - 12 movements.
The starting position is the same as in the previous exercise, but the arms are lowered along the body. Then a slight forward bend is performed while inhaling, hands reach for the floor, but it is unnecessary to get it. On exhalation, a person straightens up, but not completely. The optimal pace is 100 small inclines per minute. The exercise must also be repeated 8 - 12 times.

After the base is mastered, you can add new exercises one by one. These include:

Turns the head, inhale to the right, return to the starting position - exhale, then to the left - inhale. You need to start the exercise with an inhalation. Starting position - straight, legs narrower than shoulders;
Head tilts. The starting position is the same. Head tilt to the right - inhale, return - exhale, to the left - inhale, while trying to touch the shoulder with the ear;
Head tilts. Forward inhale, return - exhale, backward - inhale;
Starting position: straight, right leg laid back. The body weight is on the left leg, the right one is bent and placed on the toe. Then you need to sit down on your left leg, taking a strong breath. Change legs and repeat the exercise;
Step forward. Become straight with your legs narrower than your shoulders. Raise the left leg bent at the knee to the level of the abdomen, while the toe stretches down. Sit down on your right leg with a noisy inhalation. Return to starting position, change legs and repeat the exercise. Step back. The left leg is bent at the knee so that the heel reaches the buttock. Sit on your right leg while inhaling. Come back, change legs, repeat. It is optimal to take 8 times 8 breaths.

Breathing according to the Buteyko system

This technique consists in a gradual decrease in the depth of breathing, until it becomes completely shallow. A series of exercises requires little preparation. First you need to sit on the edge of any hard surface, keeping your back straight. Hands are placed on your knees, the gaze is directed just above eye level. Then the diaphragm is completely relaxed.

Now you can start breathing. It should be superficial and silent. If done correctly, you will soon feel a lack of oxygen. The recommended duration of this exercise is 10-15 minutes. If you need to take a deeper breath, it is also performed only with the upper part of the sternum. You cannot deepen your breathing. This completes the preparation and the turn of the exercises comes.

The first is the following: inhale, exhale, pause, 5 seconds for each of the actions. Repeat 10 times. When performing, only the upper lungs should be used.
In the next exercise, you need to take a full breath with the entire chest and diaphragm. Inhalation is carried out for 7.5 seconds so that it gradually rises up from the diaphragm to the sternum. Then exhale - also 7.5 seconds. Withstand 5 seconds of pause, repeat the exercise 10 times.
Hold your breath and massage the points on the nose. This exercise is done only once, no repetitions.
Repeat exercise 2, pinching the right or left nostril, saddle 10 repetitions for each nostril.
Repeat exercise 2 with the abdomen pulled in throughout the exercise.
Full ventilation of the lungs. To do this, 12 maximally deep breaths are made, each takes no more than 2.5 seconds. The exercise lasts 1 minute, and then, on exhalation, the maximum possible pause is made.
Four-level breathing. First, exercise 1 is done for 60 seconds. Then inhale, pause, exhale, pause, each stage is also 5 seconds long. It takes 2 minutes. After that, each of the stages is lengthened to 7.5 seconds. Duration 3 minutes. Then inhale, pause, exhale, pause lasts 10 seconds. There are 1.5 exercises per minute. The total duration of the execution is 4 minutes. Gradually increasing the time, it is advisable to strive for the result of one breath per minute.
Inhale, hold your breath for as long as possible, exhale, again hold your breath for as long as possible. This exercise is done only once.

At the end, the preparatory exercise is repeated. It is important to do the exercises described on an empty stomach, thoughtfully and with concentration, without being distracted by anything in the process.

Contraindications

Despite all the benefits of breathing exercises, there are contraindications to them. These include:

Insulin-dependent diabetes mellitus;
Mental abnormalities and mental illnesses, due to which a person does not understand what exactly he is doing;
Diseases of the teeth;
Chronic tonsillitis;
Severe bleeding;
Acute stage of infectious diseases;
Aneurysm;
Rehabilitation period after heart surgery.

The use of breathing exercises during pregnancy should be discussed with a doctor, a specialist will suggest the exercises necessary for the expectant mother.

3.1. Therapeutic physical culture is used in the absence of severe cardiovascular failure. The systematic performance of physical exercises helps to increase the elasticity of the lungs, preserve the mobility of the chest, maintain the state of compensation of the cardiovascular system as a whole, since they increase the function of the auxiliary mechanisms of hemodynamics, strengthen the heart muscle. Along with the improvement of gas exchange processes and the function of blood circulation, dosed muscular activity provides a tonic effect on the central nervous system and other organs and systems. General toning exercises for all muscle groups must be performed at an average or slow pace, combining them with rhythmic breathing.

Since irreversible changes occur in the lung tissue, therapeutic physical culture must first of all solve the problem of forming compensatory mechanisms that provide an improvement in lung ventilation and an increase in gas exchange in them. This is achieved by strengthening the muscles of exhalation, increasing the mobility of the chest and especially the development of diaphragmatic breathing and mastering the breathing mechanism with prolonged exhalation. Extended exhalation with simultaneous active mobilization of the respiratory function of the diaphragm reduces the amount of residual air and thereby improves gas exchange. An increase in the mobility of the chest and excursion of the diaphragm also creates conditions that facilitate the work of the heart. For this, tilts, turns and rotation of the body are used. The increase in mobility in the thoracic spine is achieved in the initial position from the top.

With emphysema of the lungs, complicated by heart failure, physical therapy is prescribed during a period of pronounced decrease in congestion. The classes include exercises performed with a low load (movements in the distal extremities), at a slow and medium pace, in the starting position with the body raised. These exercises are aimed at improving peripheral circulation. In addition, they include exercises that provide metered venous flow to the heart (rhythmic limb movements performed with incomplete amplitude at a slow pace). Movements should be alternated with rest pauses and breathing exercises with an extended exhalation. Diaphragmatic breathing should be activated with the retraction of the abdominal wall on exhalation. Subsequently, they move on to a combination of movements with breathing with an enhanced expiratory phase. If the mobility of the chest is significantly limited, during the exercise it is recommended to squeeze it with your hands as you exhale. Muscle relaxation exercises are also used.

The density of the session is low, with frequent rest pauses. With an increase in shortness of breath and cyanosis, the total load of the exercise should be reduced.

With the elimination of the phenomena of circulatory failure, you can perform exercises from the initial sitting and lying position. Taking into account the significantly reduced adaptability of patients to physical activity, exercises involving large muscle groups should be repeated at first only 2-4 times, gradually increasing the range of motion. Exercises to increase chest mobility should be done at a slow pace, often including rest pauses.

With the improvement of the condition of the patients and their increase in their adaptability to physical activity, the motor regime expands: movements that cover large muscle groups are added, exercises are carried out from the initial lying position, sitting and standing, the distance in therapeutic walking gradually increases.

3.2. Exercise therapy is used in the absence of deterioration in health or severe cardiovascular failure. In the classroom, exercises of low and moderate intensity are used. Exercises of a high-speed and speed-strength nature are used very limitedly - with the participation of only small muscle groups. Conversely, moderate physical activity, although more prolonged (especially when movements are performed smoothly, rhythmically, in coordination with breathing), has a beneficial effect on the patient. Straining and holding your breath are inadmissible. Breathing exercises of a static and dynamic type with an extended exhalation are used; to enhance the emphasis on exhalation, some exercises are also performed with the pronunciation of sounds and sound combinations. In some cases (especially in elderly patients), it is necessary to evenly develop both inhalation and exhalation. To enhance exhalation, the chest is squeezed from the sides (either the patient himself or the exercise therapy methodologist) in the second half of the exhalation. Much attention is paid to the training of diaphragmatic breathing and exercises to increase the mobility of the chest and spine: in addition to improving the function of external respiration, they facilitate the work of the heart. These exercises are bends, twists and turns of the trunk, combined with free breathing. In cases where patients develop respiratory failure, which is aggravated by cardiovascular failure, and the patient's condition becomes severe, the nature of exercise therapy changes. Classes are held in bed. Physical activity is minimal: movements in the distal parts of the limbs, performed at a slow, and then at an average pace in a reclining position, with a raised upper body. Exercises alternate with rest pauses and breathing exercises with an extended exhalation. Diaphragmatic breathing is activated. Some exercises are accompanied by squeezing the chest (exercise instructor) at the final stage of exhalation. The density of the lesson is low; as the adaptation of the organism to physical activity improves, the SP changes. (sitting and standing) and the nature of the exercises performed (medium and large muscle groups are involved in the work); the number of repetitions and the number of exercises themselves increases; the ratio of breathing and general developmental exercises is 1: 2. In the future, when the condition improves, the patient can be prescribed dosed walking; at the beginning 50-100 m at a slow pace, in combination with a prolonged exhalation; gradually the distance increases to 200-300 m.

Symbols used in the text: IP - initial position; TM - slow pace; TS - average pace.

1. Walking in place with a change in pace. 30 sec. Breathing is even.

2. IP - standing, arms to the sides. Turns of the body to the left and to the right. TM. 6-8 times in each direction.

3. IP - standing, hands on the belt. Tilts left and right. TS. 5-7 times in each direction.

4. IP - standing. Hands to the sides - inhale, tilt the body forward, clasping the chest - exhale. TS. 4-6 times.

5. IP - standing, hands on the belt. Straighten your right leg, arms forward - inhale; return to IP - exhale. TS. 5-7 times with each leg.

6. IP - sitting. Take your arms to the sides - inhale, lean forward - exhale. TM. 4-6 times.

7. IP - standing, hands on the belt. Tilts left and right. TS. 5-7 times in each direction.

8. IP - hands to shoulders. Rotation of the hands back and forth. 5-8 times in each direction. TS.

9. IP - standing with the left side of the chair. Tilts left to right. TS. 4-6 times in each direction.

10. IP - standing. Take your left leg back, arms up - inhale; return to IP - exhale. The same with the other leg. TS. 5-7 times with each leg.

11. IP - standing. Hands up - inhale; tilt of the head, shoulders (hands down) - exhale. TM. 4-6 times.

12. IP - sitting. Hands to shoulders - inhale; lower elbows, tilt forward - exhale. TM. 4-6 times.

13. IP - standing. Hands up - inhale; sit down - exhale. TM. 5-7 times.

14. IP - standing, gymnastic stick from behind. Taking the hands back; at the same time bend. TM. 4-6 times. Breathing is even.

15. IP - standing bent over, arms forward. Turns of the body to the left and to the right. TS. 5-7 times in each direction.

16. IP - standing, hands up. Leaning forward. TM. 4-6 times.

17. Walking around the room 30-60 sec.

Emphysema of the lungs. The disease is associated with the expansion of the alveoli, atrophy of the alveolar septa, reduced elasticity of the lung tissue. The persistent symptoms of this disease are shortness of breath, cough. Physical therapy helps to improve breathing (especially exhalation), increase the mobility of the diaphragm, strengthen the intercostal muscles, as well as the abdominal muscles.